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How Common Are Non-Acute Coronary Syndrome

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How Common Are Non-Acute Coronary Syndrome Te ara tika o te hauora hapori Journal of the New Zealand Medical Association Vol 134 | No 1537 | 25 June 2021 Improving care, reducing the burden Spatial, temporal and socioeconomic patterns of illicit drug use in New Zealand assessed using wastewater-based epidemiology timed to coincide with census Social impacts and costs of schizophrenia: The competition is next door! Why a a national cohort study using New Zealand voluntary approach to tobacco retailer linked administrative data reduction will never work Te ara tika o te hauora hapori Publication Information published by the New Zealand Medical Association NZMJ Editor NZMA Chair Professor Frank Frizelle Dr Alistair Humphrey NZMJ Production Editor NZMA Communications Manager Richard Beer Simon Bradwell Other enquiries to: NZMA To contribute to the NZMJ, first read: PO Box 156 www.nzma.org.nz/journal/contribute The Terrace Wellington 6140 © NZMA 2021 Phone: (04) 472 4741 To subscribe to the NZMJ, email [email protected] Subscription to the New Zealand Medical Journal is free and automatic to NZMA members. Private subscription is available to institutions, to people who are not medical practitioners, and to medical practitioners who live outside New Zealand. Subscription rates are below. All access to the NZMJ is by login and password, but IP access is available to some subscribers. Read our Conditions of access for subscribers for further information www.nzma.org.nz/journal/subscribe/conditions-of-access If you are a member or a subscriber and have not yet received your login and password, or wish to receive email alerts, please email: [email protected] The NZMA also publishes the NZMJ Digest. This online magazine is sent out to members and subscribers six times a year and contains selected material from the NZMJ, along with all obituaries, summaries of all articles, and other NZMA and health sector news and information. Subscription rates for 2021 New Zealand subscription rates Overseas subscription rates Individuals* $349 Individual $486 Institutions $604 Institutions $650 Individual article $33 Individual article $33 *NZ individual subscribers must not be doctors (access is via NZMA Membership) New Zealand rates include GST. No GST is included in international rates. Note, subscription for part of a year is available at pro rata rates. Please email [email protected] for more information. Individual articles are available for purchase by emailing [email protected] NZMJ 25 June 2021, Vol 134 No 1537 ISSN 1175-8716 © NZMA 2 www.nzma.org.nz/journal CONTENTS EDITORIALS 56 8 Antipsychotic and sedative Improving care, medication use in long-term care reducing the burden facilities providing dementia care Wayne Miles Etuini Ma’u, Janine Burton, Elizabeth Fussell ARTICLES 66 11 Social impacts and costs of Spatial, temporal and schizophrenia: a national cohort socioeconomic patterns study using New Zealand linked of illicit drug use in New Zealand administrative data assessed using wastewater-based Sheree Gibb, Naomi Brewer, epidemiology timed to Nicholas Bowden coincide with census Mackay Price, Chris Wilkins, VIEWPOINTS Benjamin J Tscharke, Tom Baker, Jochen F Mueller, Sam Trowsdale 84 Cannabis Legalisation and Control 27 Bill: should doctors be concerned? Reducing the MRI outpatient Guna Kanniah, Shailesh Kumar waiting list through a capacity CLINICAL CORRESPONDENCE and demand time series improvement programme 91 Heera Bhullar, Bernadette County, Zoledronate-induced anterior Stuart Barnard, Anne Anderson, uveitis, scleritis and optic Mary E Seddon neuritis: a case report 36 Laura E Wolpert, Andrew R Watts Does research help to inform a 95 district health board’s purpose? Vildagliptin-induced A qualitative thematic analysis of bullous pemphigoid clinician researcher views Annabelle Yi Zhang, Paul Jarrett Lorraine Neave, Duncan Reid, Brian McKenna 98 Endogenous endophthalmitis 43 following CT colonography How common are non-acute Deepesh Mehta, Helen Long, Neil Aburn coronary syndrome (ACS) diagnoses in patients with LETTERS suspected ACS investigated with 100 coronary angiography in New The competition is next door! Zealand? (ANZACS-QI 58) Why a voluntary approach to Charles Yao-Cheng Hoa, tobacco retailer reduction Mildred Lee, Seif El-Jack, Peter Barr, Mark Simmonds, Gerry Devlin, will never work Richard Portch Philip D Adamson, Michael Williams, Andrew J Kerr NZMJ 25 June 2021, Vol 134 No 1537 ISSN 1175-8716 © NZMA 3 www.nzma.org.nz/journal CONTENTS 100 YEARS AGO 113 103 Proceedings for the 254th Rapture of the Urinary Bladder Otago Medical School Research 1921 Society Research Speaker Awards, Wednesday 24 June 2020 PROCEEDINGS 115 104 Abstracts for the 253rd Proceedings for the 256th Otago Medical School Research Otago Medical School Research Society Summer Student Sepeaker Society Masters/Honours Student Awards, Wednesday 22 April 2020 Speak Awards, Wednesday 4 November 2020 109 Abstracts for the 255th Otago Medical School Research Society PhD Student Speaker Awards, Wednesday 19 August 2020 NZMJ 25 June 2021, Vol 134 No 1537 ISSN 1175-8716 © NZMA 4 www.nzma.org.nz/journal SUMMARIES Spatial, temporal and socioeconomic patterns of illicit drug use in New Zealand assessed using wastewater-based epidemiology timed to coincide with census Mackay Price, Chris Wilkins, Benjamin J Tscharke, Tom Baker, Jochen F Mueller, Sam Trowsdale Wastewater samples were collected across seven sites in three regions of New Zealand to coincide with the 2018 census. This provided a way to quantify drug use and sociodemographics and assess the accuracy of drug survey techniques. The data show the expected regional, sub-regional and temporal patterns of illicit drug use, such as more MDMA consumed on the weekends than during the week. The key take home messages is that, in combination with complementary data like censuses, surveys and seizure information, wastewater analysis can help guide harm reduction policy for the wellbeing of New Zealand. Reducing the MRI outpatient waiting list through a capacity and demand time series improvement programme Heera Bhullar, Bernadette County, Stuart Barnard, Anne Anderson, Mary E Seddon A partnership between Ko Awatea and the radiology department at Counties Manukau District Health Board aimed to match the demand for magnetic resonance imaging (MRI) with the available capacity. Using quality improvement techniques, the team successfully and sustainably reduced the MRI waiting list over a two-year period, reducing the number of patients waiting from nearly 2,000 to just over 400. The innovative solutions to segment the waiting list and match capacity to demand may be instructive for other radiology depart- ments, and other waiting list scenarios. Does research help to inform a district health board’s purpose? A qualitative thematic analysis of clinician researcher views Lorraine Neave, Duncan Reid, Brian McKenna This study explored, from a district health board (DHB) staff perspective, what the enablers and barriers to doing research were and whether the outcomes of research activity helped it deliver best care. It has provided insight into how organisational factors can negatively influence engagement in and with research and thereby impact the potential for research to inform the DHB’s overarching purpose. These factors are all modifiable influences. The themes offer a direction for the DHB’s future research strategy, where research activity is integrated into practice, where research evidence is discussed and where research achieve- ments are celebrated. The findings from this study will likely resonate across New Zealand’s DHB landscape. How common are non-acute coronary syndrome (ACS) diagnoses in patients with suspected ACS investigated with coronary angiography in New Zealand? (ANZACS-QI 58) Charles Yao-Cheng Ho, Mildred Lee, Seif El-Jack, Peter Barr, Mark Simmonds, Gerry Devlin, Philip D Adamson, Michael Williams, Andrew J Kerr Falsely activated coronary catheter laboratories for acute ST elevation heart attacks are low in New Zealand. Non-ACS conditions receiving invasive coronary angiography varies between DHBs requires more investigation. NZMJ 25 June 2021, Vol 134 No 1537 ISSN 1175-8716 © NZMA 5 www.nzma.org.nz/journal SUMMARIES Antipsychotic and sedative medication use in long-term care facilities providing dementia care Etuini Ma’u, Janine Burton, Elizabeth Fussell This study aimed to quantify the use of antipsychotic and sedative medications in residents with dementia in long-term care facilities in the Waikato and identify factors associated with the prescription of these medications. Despite the increasing evidence around the relatively poor efficacy and increased risks associated with antipsychotic and sedative prescription in individuals with dementia, this study shows the use of these medications in dementia care and psychogeriatric facilities remains high, with 48.2% of residents in this study currently prescribed an antipsychotic and 22.1% prescribed a sedative. Furthermore, less than 20% of those prescribed an antipsychotic or a sedative had the most recent dose change occur within the 12 weeks recommended by guidelines, with over 30% of those prescribed an anti- psychotic and 48% of those prescribed a sedative not having their dose adjusted for over a year. With clear evidence of the risks of antipsychotics in dementia, the proportion of resi- dents prescribed an antipsychotic or sedative in this study, in conjunction with the prolonged duration of prescription, is cause for concern and needs addressing. Social impacts and costs of
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